G281 – Chemotherapy - Each Additional Standard Chemotherapy Agent, Other Than Initial Agent
OHIP Diagnostic & Therapeutic Procedures Code — Injections or Infusions · Schedule of Benefits
Chemotherapy (pharmacologic therapy of malignancy or autoimmune disease) - with administration supervised by a physician for intravenous infusion for treatment of malignant or autoimmune disease. The physician must be available to intervene in a timely fashion at the initiation and for the duration of the prescribed therapy to manage immediate and delayed toxicities. This fee is for each additional standard chemotherapy agent, other than the initial agent. Commentary: Examples of standard chemotherapy agents include cyclophosphamide, methotrexate, fluorouracil, leucovorin, and zoledronic acid. () This service includes venipuncture, establishment of any vascular access line and administration of agent(s). ()
When to Use
- Use G281 for every subsequent standard chemotherapy agent administered during the same session after the initial agent has been billed using G381, G345, or G359.
- Apply this code when administering multiple distinct standard agents, such as adding leucovorin to a fluorouracil infusion, provided the initial agent is already claimed.
Common Pitfalls
- Billing G281 without a primary chemotherapy code (G381, G345, or G359) on the same claim will result in an automatic rejection.
- Attempting to bill a separate venipuncture or vascular access fee (e.g., G389) is prohibited, as these are considered bundled into the G281 service.
- Submitting an assessment code (e.g., A007) for the same patient on the same day is a common audit trigger, as all assessments are included in the chemotherapy fee for 24 hours.
Billing Tips
- Ensure the specific name and dosage of each additional agent are clearly documented in the chart to justify multiple units of G281 if multiple agents are administered.
Effective: April 1, 2025
Diagnostic and Therapeutic Procedures
Injections or Infusions
Procedure
Diagnostic and Therapeutic Procedures
In accordance with , the medical record must establish that an insured service was provided, the service for which the account is submitted is the service that was rendered, and the service was medically necessary.
The chemotherapy administration, including the specific additional agent(s), must be documented in the patient's medical record.
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